Pujji Ojas, Keswani Nikita, Collier Naomi, Black Marion, Doos Lucy
College of Medical and Dental Sciences, University of Birmingham, UK.
Institute of Applied Health Research, University of Birmingham, UK.
Orthop Rev (Pavia). 2017 Mar 29;9(1):6833. doi: 10.4081/or.2017.6833. eCollection 2017 Feb 20.
The aim of our review is to identify the reconstruction technique that has a superior functional outcome and decreased number of complications for the anterior cruciate ligament (ACL). We have divided our review into 2 sections. Our primary question evaluates the functional results and complications of autografts compared to allografts for ACL reconstruction. Our subsidiary question evaluates the functional results and complications of bone-patellar tendon-bone (BPTB) autografts compared to hamstring tendon autografts. We conducted a systematic review (SR) based on high quality evidence provided by Cochrane, PubMed and National Health Service evidence searches for papers comparing different ACL reconstruction techniques. Results from 2 primary studies, 1 SR and 1 meta-analysis showed no significant statistical difference when comparing clinical outcomes such as pain, range of motion, laxity, International Knee Documentation Committee score, single assessment numerical evaluation score, Tegner activity score and patient reported satisfaction with regards to autografts allografts. Allografts had worse outcomes for postoperative tibial tunnelling and graft failure. Results of 3 SRs showed statistically significant differences in incidence of anterior knee pain, kneeling pain and knee stability, which were all found to be greater amongst those who had received a BPTB autograft. Knee extension was significantly reduced in patients with BPTB grafts when compared to patients with Hamstring tendon autografts. However, with regards to return to prior levels of activity, there was no statistically significant difference between those that received BPTB autografts and those that received Hamstring tendon autografts. Autograft reconstruction of the ACL was shown to provide better postoperative outcomes when compared to allograft reconstruction, although the difference was not statistically significant. When researching different autograft options BPTB autografts were associated with greater pain but also greater stability of the knee joint postoperatively when compared to hamstring tendon autografts.
我们本次综述的目的是确定在前交叉韧带（ACL）重建中，哪种重建技术能带来更优的功能结果并减少并发症数量。我们将综述分为两个部分。我们的主要问题是评估自体移植物与同种异体移植物用于ACL重建时的功能结果和并发症情况。我们的次要问题是评估髌腱骨（BPTB）自体移植物与腘绳肌腱自体移植物的功能结果和并发症情况。我们基于Cochrane、PubMed以及英国国家医疗服务体系证据检索所提供的高质量证据，对比较不同ACL重建技术的论文进行了系统综述（SR）。两项主要研究、一项SR和一项荟萃分析的结果显示，在比较疼痛、活动范围、松弛度、国际膝关节文献委员会评分、单项评估数值评定评分、Tegner活动评分以及患者报告的对自体移植物与同种异体移植物的满意度等临床结果时，未发现显著的统计学差异。同种异体移植物在术后胫骨隧道形成和移植物失败方面的结果更差。三项SR的结果显示，前膝痛、跪姿疼痛和膝关节稳定性的发生率存在统计学显著差异，这些在接受BPTB自体移植物的患者中均更高。与接受腘绳肌腱自体移植物的患者相比，接受BPTB移植物的患者膝关节伸展明显减少。然而，在恢复到先前活动水平方面，接受BPTB自体移植物的患者与接受腘绳肌腱自体移植物的患者之间没有统计学显著差异。与同种异体移植物重建相比，ACL自体移植物重建显示出更好的术后结果，尽管差异无统计学意义。在研究不同的自体移植物选择时，与腘绳肌腱自体移植物相比，BPTB自体移植物术后疼痛更严重，但膝关节稳定性也更高。
